August 29, 2012

Stephen, a character in the BBC's The AccusedLast night’s episode of The Accused approached the issue of the mental health of 17 year old Stephen, who began experiencing symptoms of psychosis after losing his mother to cancer. It got loads of people talking and debating about how psychosis was portrayed, both positive and negative.

Difference of opinion on The Accused mainly focused on stigma and prejudice. Some felt that it reinforced stereotypes and misconceptions of people with mental illness, particularly that those with psychosis are violent and dangerous. But what I saw was a moving and powerful insight into the mind of a vulnerable teen. I empathised, I watched intently, and I definitely came away from the programme with a greater understanding of what it’s like to experience severe symptoms of psychosis.

Many people are worried that someone with a mental health problem will attack them but you’re actually more likely to get struck by lightning. In fact, the people who commit the most violent crimes are young males influenced by alcohol. What The Accused showed is that untreated symptoms can escalate into a place of darkness, isolation, and desperation, which can result in violence. It focused on one person’s experience and didn’t generalise. Most importantly, it highlighted Stephen’s deterioration and the failure of those around him to help.

early signs that Stephen was struggling with his mental health were ignored by his family

Evidence suggests that the earlier psychosis is recognised and treated, the better the outcome. But early signs that Stephen was struggling with his mental health were ignored by his family; from angry outbursts, to smashing up his TV because he thought the people on the programmes were talking about him.

We saw the reluctance of Stephen’s father to get him medical help, how this led to further deterioration in Stephen’s mental health and, eventually, in him being thrown out of their family home. It showed the very real impact of one person’s mental health on the people around them and how their reactions can have a huge impact on recovery. That’s why the young people’s phase of the Time to Change campaign focuses on educating and empowering parents too.

Stephen’s behaviour seemed to shift... to increasingly worrying symptoms such as hallucinations

Stephen’s behaviour seemed to shift from normal reactions to grief, such as anger, blame and flashing memories of his mother, to increasingly worrying symptoms such as hallucinations. We saw certain triggers in Stephen’s life that pushed him further into the world of delusion and warped reality: the nurse moving into his house and an argument about washing up in which the nurse accused his mother of raising him improperly.

And all the way through, I felt that we, as an audience, experienced the journey with Stephen from his perspective; experiencing the same paranoia and confusion. Is the dog really growling at the nurse, or is this just Stephen’s perception? Are we seeing her through his eyes, or reality? It allowed us to empathise with Stephen more and no matter how violent or unpredictable he became, I always felt that I was on his side.

I hope it will put the audience in the shoes of someone with a mental health problem

One of the techniques we’re using in the young people’s Time to Change campaign is to involve those with personal experience of mental illness as much as possible in the delivery of the campaign. This includes real life accounts from volunteers in our education programme about experiencing mental illness in their teens. I hope it will put the audience in the shoes of someone with a mental health problem, in the same way as we were in Stephen’s last night.

There’s no denying that Stephen was unwell. Even though the last scene led us to question whether the nurse was really poisoning the family and Stephen was in fact correct, we cannot ignore the voices he was hearing and other hallucinations throughout. But that did make me wonder whether the programme was trying to tell us something else; that stigma means that those with mental illness are not trusted or believed, even when what they are seeing is real.

I felt the most powerful reference to stigma came in the form of the court scene 

I felt the most powerful reference to stigma came in the form of the court scene where the lawyer tries to persuade Stephen to get a psychiatric assessment. It highlighted how expectations of what treatment and recovery will involve actually stops people with mental health problems from seeking help. It’s certainly the quote that haunted me the most.

Dad: “Will it reduce his sentence?”
Lawyer: “It might”
Stephen: “No. No it won’t. Say nothing, the judge gives me x number of years, I do them and I come out. Say I’m mad, he puts me in hospital and I stay there until I can prove that I’m not mad. And that could be forever."

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